Exam 3 Forum Questions
3. A client with diabetes complains of paresthesias. Which of the following medications can cause sensory changes? A. Glipizide B. Sitagliptin (Januvia) C. Metformin D. Exenatide (Byetta)
. Answer C A rare adverse effect of metformin is megaloblastic anemia due to impaired absorption of vitamin B 12. This can be prevented by administration of vitamin B 12 along with folic acid. Nerve degeneration often begins early in the course of diabetes and can also cause paresthesias. Nerve damage is directly related to sustained hyperglycemia, which may cause metabolic disturbances in nerves or may injure the capillaries that supply nerves. Diabetic neuropathy necessitates vigilance in the care of the extremities to prevent damage.
5. The mechanism of action of metformin (Glucophage®) is as: A. an insulin-production enhancer. B. a product virtually identical in action to sulfonylureas. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. D. a facilitator of renal glucose excretion.
. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. Metformin works by a variety of mechanisms. It reduces hepatic glucose production as well as intestinal glucose absorption. It also acts as an insulin sensitizer by way of increased peripheral glucose uptake and utilization (C). Incorrect: GLP-1 agonists and DPP-4 inhibitors work by enhancing insulin production (A). A sulfonylurea works as an insulin secretagogue, which increases the release of insulin from beta cells (B). Facilitation of renal glucose excretion is the mechanism of action of SGLT2 inhibitors (D).
2. Sara has diabetes and is now experiencing anhidrosis on the hands and feet, increased sweating on the face and trunk, dysphagia, anorexia, and heartburn. Which complication of diabetes do you suspect? A. Macrocirculation changes B. Microcirculation changes C. Somatic neuropathies D. Visceral neuropathies
2. Answer D Visceral neuropathies, also known as autonomic neuropathies, include anhidrosis (absence of sweating) on the hands and feet, increased sweating on the face or trunk, dysphagia, anorexia, heartburn, constricted pupils, nausea and vomiting, constipation, and diabetic diarrhea. Macro-circulation changes include an early onset of atherosclerosis and peripheral vascular insufficiency with claudication, ulcerations, and gangrene of the legs. Microcirculation changes include diabetic retinopathy with retinal ischemia and loss of vision and diabetic nephropathy with hypertension, albuminuria, edema, and progressive renal failure. Somatic neuropathies include changes in sensation in the feet and hands; palsy of cranial nerve III with headache, eye pain, and inability to move the eye up, down, or to the middle; pain or loss of cutaneous sensation over the chest; and motor and sensory deficits in the anterior thigh and medial calf.
4. Morton has type 2 diabetes. His treatment, which includes diet, exercise, and oral antidiabetic agents, is insufficient to achieve acceptable glycemic control. Your next course of action is to: A. increase the dosage of the oral antidiabetic agents. B. add a dosage of long-acting insulin at bedtime to the regimen C. discontinue the oral antidiabetic agents and start insulin therapy. D. suggest treatment using an insulin pump.
4. Answer B If treatment with diet, exercise, and oral antidiabetic agents is insufficient to achieve acceptable glycemic control in clients with type 2 diabetes, adding a dose of insulin at bedtime to the regimen may be necessary. As a first step, the addition of a bedtime injection of long-acting insulin such as insulin glargine (Lantus) or insulin detemir (Levemir) is recommended. Intermediate acting insulin such as neutral protamine Hagedorn (NPH) is no longer recommended because of the peaks in drug levels that can cause hypoglycemia. Initially, the dosage is 10 units at bedtime; then the dose is adjusted to reduce overnight hepatic glucose production and achieve a normal or near normal fasting blood glucose concentration. If this regimen does not achieve the desired effect, the oral antidiabetic agents should be discontinued, and mealtime analogue rapid-acting insulin can be added to the largest meal. Most clients will eventually require four injections with the basal bolus regime.
A 36-year-old woman presents to the clinic with complaints of vaginal discharge for the past two weeks. She says that the discharge has been disrupting her day to day life by soiling her undergarments. She describes the discharge as thick and white; however, she states that it is not foul-smelling. She has also had an itching sensation in her vagina and has trouble with vaginal penetration. She has tried leftover antifungal creams from the last time she had similar complaints. However, none of them seem to have worked. Her periods are regular and are due in 2 days. She is sexually active and uses condoms irregularly with her husband. Examination shows normal vitals and a thick, white discharge present in her vaginal introitus. Cervical motion tenderness is absent, and abdominal examination is noncontributory. What is the next best step in the management of this patient? 1. Oral fluconazole2. Obtain pelvic ultrasound3. Oral azithromycin4. Check serum beta-human chorionic gonadotropin
4. Check serum beta-human chorionic gonadotropin Teaching PointsThis patient most likely has vaginal candidiasis.Candidiasis can be treated with topical antifungals like miconazole and clotrimazole and oral antifungals like fluconazole.This patient, however, is not a suitable candidate for oral fluconazole because she might be pregnant.Fluconazole may be used in pregnancy; however, waiting two days to assess whether the patient is pregnant or not and then providing her with the relevant data is the most suitable step provided. She refuses to use topical antifungals. Fluconazole is associated with an increased risk of miscarriages, and therefore must be used cautiously in pregnant women.
45. The use of which of the following medications has the potential for causing the greatest reduction in A1c? A. a biguanide (metformin) B. a thiazolidinedione C. a sulfonylurea D. an insulin form
45. Correct: D. an insulin form The A1c reduction potential of insulin is essentially limitless, as the dose can be easily adjusted based on hyperglycemia status (D). Incorrect: The anticipated A1c reduction of metformin (A), thiazolidinediones (B), and sulfonylureas (C) with intensified use are all in the range of 1% to 2%.
. Which of the following is representative of the presentation of secondary syphilis? A. generalized rash B. chancre C. pupillary alterations D. aortic regurgitation
A
A 30-year-old woman presents without symptoms but states that her male partner has new-onset dysuria without penile discharge. Examination reveals a friable cervix covered with thick, yellow discharge. This description is most consistent with an infection caused by: A C trachomatis B N gonorrhoeae C HSV D T vaginalis
A
Hemorrhagic cystitis is characterized by: A. irritative voiding symptoms B. persistent microscopic hematuria C. the presence of hypertension D. elevated creatinine and BUN levels
A
The preferred treatment option for Trichomoniasis is: A Oral Metronidazole B Clindamycin vaginal cream C Oral Acyclovir D Oral Azithromycin
A
Which of the following accounts for half of the bladder tumors among men and one-third of women? A. Cigarette smoke, both active and passive inhalation. B. Chemicals from plastic and rubber. C. Chronic use of phenacetin-containing analgesic agents. D. Working long hours and not voiding often.
A
Why are you at a greater risk for heart disease and stroke when you are in metabolic syndrome? A Due to a proinflammatory and prothrombic state B Due to dysfunction of hormones C Due to insufficiency of glucocorticoids
A
Which of the following is an unlikely consequence of untreated metabolic syndrome in a woman of reproductive age? Hyperovulation Irregular menses Acne Hirsutism
A hyperovulation
You are treating Mr. George, age 65, for HIV. He is on antiretroviral therapy and sexually active. You know the risk of HIV transmission is... A. negligible when an HIV-positive sex partner adheres to antiretroviral therapy B. zero risk with condom use whether on antiretroviral therapy or not. C. a combination of both condoms and intiretroviral therapy is needed. D. He hsould not have seaat all to avoid possible transmission
A. Recent research has confirmed that sexual transmissionof HIV is neglible when an HIV positive sex partner adheres to antiretroviral therapy and manitains viral suppression. It was foind that while the risk was low, there was still transmission with condom only use. With antiretroviral therapy and a viral load of less than 200 copies/mL across consecutitive measurements there were no transmissions.
Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.
A. bone thinning. When using levothyroxine to treat hypothyroidism, the dose should be titrated to achieve normal TSH levels. Excessive use of levothyroxine will lead to diminished TSH level and signs and symptoms of hyperthyroidism, which can lead to bone thinning (A). Incorrect: Excessive levothyroxine can lead to symptoms of hyperthyroidism including nervousness and irritability rather than fatigue (B), and hyperdefecation rather than constipation (D). Renal impairment is not associated with excessive use of levothyroxine (C).
How small must tuberculosis particles be for direct inhalation into the alveoli? 1-5um 1-5mm 1-5cm 1-5in
ANSWER: A (1-5um). Tuberculosis particles must be 1-5um in order for direct inhalation into the alveoli to occur.
1. The mechanism of action of sulfonylureas is as: A. an antagonist of insulin receptor site activity. B. a product that enhances insulin release. C. a facilitator of renal glucose excretion. D. an agent that can reduce hepatic glucose production.
ANSWER: B: A PRODUCT THAT ENHANCES INSULIN RELEASE Rationale: Sulfonylureas is an insulin secretagogue (Increases insulin release from Beta cells)
2. Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: A. hypoglycemia. B. hepatic impairment. C. lactic acidosis. D. interaction with most anesthetic agents.
ANSWER: C: LACTIC ACIDOSIS Rationale: Hydration status is altered in patients fasting for surgery. This places them at a higher risk for lactic acidosis. The risk for hypoglycemia is very small.
A 27-year-old male comes into the clinic with syphilis symptoms. His test results come back (+) VDRL, (+) FTA. What does this indicate? A No infection or very, very early infection B False positive C Adequately treated syphilis DSyphilis
ANSWER: D (Syphilis). A positive VDRL and FTA indicates an active syphilis infection.
1. Which of the following statements is true about insulin lispro? A. It works faster than regular insulin because its amino acid composition has been slightly modified. B. When taken 30 minutes before a meal, it reduces after-meal hyperglycemia. C. Its duration of action is about 4 - 5 hours. D. It is taken with the first bite of food.
Answer A Insulin lispro is a rapid-acting human insulin whose amino acid composition has been slightly modified to make it work faster. It is administered 5 - 10 minutes before meals and reduces after-meal hyperglycemia to a greater extent than does regular insulin. Its duration of action is about 3 hours, rather than the 5 - 6 hours of regular insulin. Because of this, lispro reduces the risk of hypoglycemia between meals and during the night.
A first line approach in the treatment of Cushing's syndrome in a 56 year old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past two years is? A. Gradually taper corticosteroid usage B. Refer for surgery C. Consideration of radiation therapy D. Prescribing mifepristone
Answer A Rationale: An exogenous cause of Cushing's syndrome is the long term use of high dose of systemic corticosteroids for the treatment of inflammatory conditions. The most common reason for Cushing's syndrome is protracted use of higher dose corticosteroids. Treatment is to taper the dosage of corticosteroids as soon as possible.
hat is the diagnostic criteria for metabolic syNdrome? (Select all that apply) A) Large waistline B) increased triglycerides C) decreased HDL D) HTN E) increased fasting blood glucose
Answer A, B, C, D, E
A 24 year old runner is diagnosed with Addison's disease. In coseling her about exercise you recommend? A. Tapering her running to only 10 minutes per day for 2 to 3 days per week B. Ceasing any prolonged strenuous exercise C. Ensuring an ample amount of sodium is ingested D. Switching to non-impact exercise
Answer C Rationale: Laboratory includes checking for sodium levels, as prolonged cardiovascular exercise can reduce these levels it is important to replace the sodium that is lost while exercising Fitzgerald, M. A. (2017). Nurse practitioner certification examination and practice preparation (
Indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise healthy 28 year old man. Dysuria ____ Milky penile discharge____ Scrotal swelling____ Fever____
Answer: Yes Yes No No
What are specific electrolyte abnormalities noted in adrenal insufficiency that the provider should monitor for: A) hyponatremia and hyperkalemia B) hypernatremia and hypokalemia C) hypomagesia D) hemohromatosis
Answer: A
What is metabolic syndrome? A) Group of risk factors that rasises group of risk factors that raises risk for heart disease and stroke B) Another name for hypoglycemia C) A group of medications to treat diabetes D) Another name for pre diabetes
Answer: A
Which chronic illness disproportionately affects the Hispanic population? A. Diabetes mellitus B. Hypertension C. Alcohol abuse D. skin cancer
Answer: A - Diabetes mellitus. The risk of diabetes mellitus is two to three times higher in Mexican Americans than in non-Hispanic Americans.
What signs and symptoms are included in adrenal crisis? (Select all that apply) A) Profound fatigue B) Dehydration C) Vascular collapse D) renal shut down E) Decreased Sodium F) increased serum potassium
Answer: A B C D E F
3. The first-line approach to treating Cushing's syndrome in a 56 year old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referal for surgery C.consideration of radiation therapy D. prescribing mifepristone
Answer: A, gradually tapering corticosteroid use. For a patient with Cushings syndrome related to long term corticosteroid therapy , first line treatment is designed to decrease the level of cortisol in the body. The best approach would be to gradually taper the dose of corticosteroids. Abrupt discontinuation should be avoided as this can lead to adrenal crisis.
3. First line treatment options for primary syphilis include: A. IM penicillin B. PO ciprofloxacin C. PO doxycycline D. IM ceftriaxone
Answer: A. The preferred treatment of primary syphilis is IM penicillin given as a one time dose.
2. An adolescent presents with diaphoresis, palpitations, slight confusion, and tachycardia following a soccer game and approximately 4 hours after taking prescribed insulin as usual. Which immediate intervention does the nurse practitioner implement? A Check blood glucose level and administer carbohydrates B Order nitroglycerin and electrocardiogram (ECG) C Check pulse oximetry and administer oxygen therapy D Assess for asthma and provide rescue inhaler
Answer: A: The patient is experiencing symptoms of hypoglycemia. Checking the blood glucose level and administering carbohydrates will elevate blood glucose. Electrocardiogram (ECG) and nitroglycerin are actions for myocardial infarction. Administering oxygen will not help correct the low blood glucose level. Assessing for asthma and providing a rescue inhaler would be needed if the patient was in respiratory distress, but all the signs and symptoms point to hypoglycemia, which would be immediate in this situation.
2) You consider prescribing insulin glargine because of its: a) extended duration of action b) rapid onset of action c) ability to prevent diabetic end-organ damage d) ability to preserve pancreatic function
Answer: A; Insuin glargine is a long-acting insulin that has a duration of action of at least 24 ours and does not have a substantial peak concentration when used
1) A 30-year-old woman with type 2 diabetes uses regular and intermediate-acting insulin in the morning and evening. She denies changes in her diet or any illness, but she recently started attending aerobic classes in the afternoon. Her fasting blood glucose level before breakfast is now elevated. Which of the following is best described? a) Somogyi phemomenon b) Dawn phenomenon c) Raynaud's phenomenon d) Insulin resistance
Answer: A; Somogyi phenomenon is caused by too much insulin (or missing a meal or snack) in the evening, which results in hypoglycemia in the early morning (2-3am). The body compensates by secreting glucagon (from the liver) and epinephrine, which results in high blood glucose levels in the morning. .The Somogyi phenomenon (or Somogyi effect) is also known as the rebound effect.
Secondary adrenal insufficiency can occur with the presence of a diseased or malfunctioning: Pituitary gland Thyroid Pancreatic beta cells Hypothalamus
Answer: A; The pituitary gland produces adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones from the adrenal gland.
2. According to the Opiod Risk Tool, a score of 8 or higher indicates a. low risk for future opiod abuse b. high risk for opiod abuse c. moderate risk for opiod abuse d. personal history of opiod abuse
Answer: B
COLLAPSE 1. Generally, testing for type 2 DM in asymptomatic, undiagnosed individuals older than 45 years should be conducted every A. year B. 3 years C. 5 years D. 10 years
Answer: B Rationale: Diabetes testing should begin at age 45. If results are normal, testing should only be repeated in 3 year intervals. More frequent testing may be considered in individuals depending on initial results and risk status.
During the early stages of iron-deficiency anemia, the red blood cells are: A. Microcytic B. Normocytic C. Macrocytic D. Hyperchromic
Answer: B Normocytic During early stages of iron-deficiency anemia, the size (MCV) of the RBCs is still normal (normocytic). But when iron stores get depleted, the size, color, and shape of the RBC will become abnormal.
2. For a patient suspected of active pulmonary TB disease, which of the following approaches is least helpful in confirming the diagnosis? A. Chest radiograph B. Gram stain from blood sample C. Acid-fast microscopy from sputum sample D. Culture and susceptibility from sputum sample
Answer: B. A gram stain of a blood sample is not sensitive or specific to detect active pulmonary TB disease.
2) Which of the following races/ethnicity is the least likely to carry a diagnosis of diabetes A. Africian Americans B. Caucasians C. Hispanics D. American Indians
Answer: B. Caucasians. We need to keep in mind that our social determinants of health affect our minority patient along with increased risk factors associated with certain ethnicities need to be taken into account when assesssing for risk factors for diabetes. Caucasians have a lower rate of diabetes than any other races. (Diabetes pt1 Powerpoint slide, Dr.DeVries, 2021)
A 30-yr old male with a history of HIV infection has been on antiretroviral therapy (ART) since diagnosis at age 28 years.which of the following indicates that the patients's immune systeim is responding to ART? A. The HIV viral load is higher compared with the previous test B. the CD4 count is higher that the previous test C. The CBC show and increase in the leukocyte count D. Hiv genetic testing of the patient's HIV strain shows that it is sensitive to current HIV regimen
Answer: B: One of the best indicators that the patient is responding to ART regimen is an increase in the CD4 count. Another indecator is a decrease in the viral load. The leukocyte count in the CBC indicates neutrophils; it does not indicate CD4 status
1. Which nonopiate medication is the first line treatment for most acute pain? a. Tylenol b. muscle relaxers c. NSAIDS d. Oxycodone
Answer: C
Which of the following is the most accurate information in caring for a 40-year-old man with cystitis? A. This is a common condition in men this age B. A gram-positive organism is the likely causative pathogen. C. A urological evaluation should be considered. D. Pyuria is rarely found
Answer: C
The first choice of therapy for a client who is positive for HIV and has oral candidiasis is... A. Fluconazole (Diflucan) 100mg PO daily B. Keotconazole (Nizioral) 200mg PO daily C. clotrimazole troches (10mg) five times daily or nystatin (mycostatin) suspension 500,000-1,000,000 unites three to five times daily D. Griseonfulvin (Grisactin) 500mg BID
Answer: C The first choice of therapy for a client who is HIV Positive and has oral candidiasis would be clotrimazole troches... Because of the common recurrence of oral candidiasis and increased rates of drug resistance, systemic fungicides, such as fucanizole , ketoconazole and griseofulvin, shoud bew resierved for severe cases, such as esophageal candidiasis and clients with dysphagia. Clotrimazone troches and nystatnin suspension are the only nonsytemic mediations listed.
Which statement made by a 24-year-old patient with diabetes mellitus indicates that education about disease management was effective? A. I will check my blood sugars at the same time I do now B. Eating small meals every 2 hours will keep my blood sugars stable C. If I feel really tired or cannot concentrate, I will call you D. I will stop taking my oral medications and just take insulin
Answer: C - If I feel really tired or cannot concentrate, I will call you. A patient with diabetes should eat small meals every 3 to 4 hours to keep blood sugars as normal as possible. Patients who have a blood sugar >300mg/dL, level of consciousness changes, or dehydration should contact the provider for advice. Blood sugars should be checked more frequently when a patient is sick, and they should not stop taking oral medications or insulin unless their fasting blood glucose is lower than expected and as per their provider's orders.
1. Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D.radioactive iodine exposure.
Answer: C, autoimminue thyroiditis. In part of the world where iodine deficiency is rare, such as the United States, autoimmune thyroiditis is leading cause of hypothyroidism. The condiditon is often linked to other autoimmune disorders.
3) Risk factors for type 2 diabetes include all of the following except: A. Advanced age B. Obesity C. Smoking D. Physical inactivity
Answer: C. Smoking. Smoking is not a risk factor for type 2 diabetes. Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites. (Test Prep Review, 2021)
3. A parent presents to the office stating their child has exhibited an extreme weight loss recently and is drinking large amounts of flavored sports drinks and water yet is always thirsty. The child has been irritable and experiencing problems at school. The nurse practitioner notes the child's breath has a "fruity" odor. What condition does the nurse practitioner suspect? A Hypoglycemia B Attention-deficit hyperactivity disorder C Type 1 diabetes D Metabolic syndrome
Answer: C: Type 1 diabetes involves polyuria, polydipsia, and weight loss. The body uses fat for fuel. Most patients diagnosed with type 1 diabetes are juveniles. The child's breath may smell "fruity" due to the buildup of ketones. Hypoglycemia and metabolic syndrome will not manifest as a "fruity" smell to the breath. Attention-deficit hyperactivity disorder does not present with excessive thirst and fruity-smelling breath.
3) In caring for a patient with DM, microalbuinuria should be obtained: a) annually if urine protein is present. b) periodically in relationship to glycemia control. c) yearly. d) with each office visit related to DM.
Answer: C; For individuals with T2DM, renal function should be evaluated at least annually. This will include serum reatinine, calculated GFR, and urine microalbumin.
3. Hemoglobin A1C best provides information on glucose control over the past: A. 1 to 29 days B. 21 to 47 days C. 48 to 63 days D. 64 to 90 days
Answer: D
2. Which of the following should be periodically monitored with the use of biguanide? A. creatine kinase (CK) B. alkaline phosphatase (ALP) C. alanine aminotransferase (ALT) D. creatinine (Cr)
Answer: D Rationale: Creatinine should be monitored, should not me initiated or continued with impaired renal function.
A female patient experiencing frequent urinary tract infections (UTIs) and vaginal infections is being seen in the office for the third time in 7 months with complaints of urinary burning and frequency, vaginal discharge, and severe itching. The nurse practitioner orders testing for which possible underlying condition? A. Diabetes insipidus B. Anemia C. Helicobacter pylori infection D. Diabetes mellitus
Answer: D - Diabetes mellitus. persistent urinary and vaginal infections may indicate underlying glucose metabolism disorders and diabetes mellitus. Diabetes insipidus is a rare metabolic disorder affecting fluid balance (excessive fluid intake and urination) in the body and would not be screened for with the symptomatology of this case. H pylori is a bacterial infection of the digestive tract and would not manifest as vaginal discharge or itching. Anemia is not a possible underlying cause for frequent UTIs or vaginal infections.
An obese Asian patient with a BMI (Body Mass Index) of 33 complains of fatigue and excessive thirst and hunger. You suspect type 2 DM. Initial testing to confirm diagnosis can include: A. Fasting plasma glucose level B. Glycated hemoglobin level (A1c) C. Oral glucose tolerance testing D. All the above
Answer: D All the above Rational: DM2 screening tests include fasting plasma glucose level (>126mg/dL), random plasma glucose level (>200mg/dL) and oral glucose tolerance tesing (2-hour blood glucose level >200 mg/dL) with a 75-g glucose load. Normal A1C (glycosylated hemoglobin) levels are <6%
Which of the following findings is associated with diabetic retinopathy? A. AV nicking B. copper wire arterioles C. Flame-shaped hemorrhages D. Microaneurysms
Answer: D Microaneurysms Rational Microaneurysms are seen with diabetic neuropathy. Arteriovenous (AV) nicking, copper wire arterioles, and flame hemorrhages are seen with uncontrolled hypertension.
A male patient has type 2DM and a "sensitive stomach." Which medicaiton is least likely to cause him gastrointestinal distress? A. Naproxen sodium (Anaprox) B. Aspirin (Bayer's aspirin) C. Erythromycin (E-mycin) D. Sucralfate (Carafate)
Answer: D Sucralfate (Carafate) Rational: Naproxen sodium, aspirin, and erythromycin all have GI side effects. Sucralfate is used to protect the somach lining by building protective layer over the stomach lining; it allows healing to occur.
2. Increased risk of thyroid disorder is found in individuals who are: A. obese B. hypertensive C. treated with sysytemic corticosteroids d. elderly
Answer: D, elderly. Recognizing patient risk factors for thyroid disorders is important in early detection and managment of these conditions. Risk factors include elderly, female gender, postpartum period, or personal family history of autoimmune disease.
Clinical presentation of progressive primary TB most commonly includes all of the following except: a. Malaise b. Fever c. Dry Cough d. Frank hemoptysis
Answer: D. Common signs and symptoms of progressive primary TB include dry cough, fever, malaise, weight loss, and night sweats. Frank hemoptysis is rarely found in TB disease
3. When treating acute pain with opiods, it is important for the clinician to remember a. The rule of thumb is to prescribe the lowest effective short release for least amount of time b. Never prescribe more than 3 to 5 days before reevaluation c. evaluate risk factors and check OARRS d. Stay away from long acting opiates e. All of the above
Answer: E
When taking iron supplements what should a patient avoid taking at the same time? A. Antacids B. Dairy products C Quinolones D. Tetracyclines E. All of the above
Answer: E. All of the above Iron binds with these substances and is inactivated.
Moderate- to- severe cases of anemia symptoms may include: A. Pallor of skin, conjunctiva, and nail beds B. Daily fatigue and exertional dyspnea C. Cravings for nonfood items such as ice or dirt (pica) D. None of the above E. A & B F. A, B & C
Answer: F- A, B, &C
1. Which of the following characteristics applies to Type 2 Diabetes (T2DM)? a. Major risk factors are heredity and obesity. b. Pear-shaped body type is commonly found. c. Exogenous insulin is needed for control of disease. d. Physical activity enhances IR.
Answer: a. Major risk factors are heredity and obesity.
2. You consider prescribing insulin glargine (Trujeo, Lantus) because of its: a. extended duration of action. b. rapid onset of action. c. ability to prevent diabetic end-organ damage. d. ability to preserve pancreatic function.
Answer: a. extended duration of action. Insuline Glargine is a long-acting insulin that has a duration of action of at least 24 hours and dose not have a substantial peak concentration when used.
3. After use, the onset of action of lispro (Humalog), a rapid-acting insulin, occurs in: a. less than 30 minutes b. approximately 1 hour c. 1 to 2 hours d. 3 to 4 hours
Answer: a. less than 30 minutes. This short-acting insulin has a rapid onset of action (usually 15-30 minutes of injection). This medication should be administered within 15 minutes of meals or immediately following meals.
1) Which symptom listed below is not a symptom of type 1 diabetes A. Extreme thirst B. Nausea/vomiting C. Decreased appetite D. Frequent urination
Answer:C. Decerased appetite. "glucose from the blood cannot enter the cells - due to either a lack of insulin or insulin resistance - so the body can't convert the food you eat into energy. This lack of energy causes an increase in hunger".
YES/NO: HIV screening is recommended for which of the following ____A 17-year-old female that states she has no risk factors for HIV and who requests the test ____A 47-year old male seeking treatment for syphilis ____A 36-year old pregnant women ____A 24-year-old male who is an injection drug user
Answers: Yes Yes Yes Yes
1. A 10-year old boy complains of sudden onset of scrotal pain upon waking that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum The cremasteric reflex is negative and the urine dipstick is negative for leukocytes, nitrites, and blood. What type of follow up should this patient receive? A Refer him to a urologist within 48 hours B Refer him to the emergency department as soon as possible C Prescribe ibuprofen (advil) 600mg QID for pain D Order a testicular ultrasound for further evaluation
B
3. Why is parathyroid hormone secretion increased during pregnancy? A. To meet the increased stress demands on the mother B. To meet the increased requirements for calcium and vitamin D for fetal skeletal growth C. To help prevent neural tube defects in the fetus D. To help promote neurological growth of the developing brain in the fetus
B
A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds in the past 2 months. She has a history of asthma requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is: A Type 2 diabetes B Cushing's syndrome C Cushing's disease D Central obesity
B
Appropriate antimicrobial treatment for a 25-year-old man with acute bacterial prostatitis is: A Oral azithromycin B IM ceftriaxone followed by oral doxycycline C Oral ofloxacin D Oral amoxicillin-clavulanate
B
For a patient suspected of active pulmonary TB disease, which of the following approaches is least helpful in confirming the diagnosis? A Chest radiograph B Gram stain from blood sample C Acid-fast microscopy from sputum sample D Culture and susceptibility from sputum sample
B
Medications known to increase the risk of renal stones include all the following except: A. sulfasalazine. B. moxifloxacin. C. topiramate. D. indinavir.
B
Risk factors for acquiring HIV include all the following except: A Sexual intercourse with HIV-infected person or with gay or bisexual men B Receiver of blood products after March 1985 C History of drug use via injection D History of other STDs, multiple partners, homeless status, or prisoner in jail
B
The American Diabetes Association (ADA) recommends the use of laboratory testing to screen for pre-diabetes in asymptomatic people. The recommendation is to perform this screening on: A All children who are overweight or obese. B All adults with a BMI > 25 with one or more risk factors for diabetes mellitus. C All adults and children as part of their complete routine physical exams. D All children who were born to mothers that have had gestational diabetes.
B
The nurse practitioner percusses for pain at the costovertebral angle when examining a male patient. What condition is the provider assessing for? A. Urethritis B. Pyelonephritis C. Kidney stone D. Bladder tumor
B
Type 2 diabetes mellitus is associated with insulin resistance. Which of the following statements about insulin resistance is true? A Patients with insulin resistance have decreased insulin production. B Insulin resistance may improve with weight loss. C Insulin resistance and type 2 diabetes mellitus are progressive diseases that will eventually lead to absolute insulin deficiency. D Insulin resistance is a genetic trait and thus cannot be altered or improved.
B
Which of the following is not a predisposing factor to acute pain? A. Recent surgery B. History of childhood trauma C. Compromised immune system D. Recent trauma/injury
B
1. A nurse practitioner is caring for a patient with insulin-dependent diabetes mellitus. What changes to the patient's daily regimen may be required during a period of infection? Select all that apply. A Add an oral antidiabetic agent B Increase fluid intake C Increase the insulin dosage D Skip insulin during this period E Monitor glucose levels until fever subsides
B C E
1. Alice, age 48, has a benign thyroid nodule. The most common treatment involves: A. surgery. B. administration of levothyroxine therapy. C. watchful waiting with an annual follow-up. D. radioactive iodine therapy.
C
1.The CDC distinguishes high-impact chronic pain as: A. Pain that occurs in the morning and lasts throughout the day B. Pain that starts during the night and persists until morning C. Pain that frequently limits life or work activities D. Pain that is less than 3 months
C
3. Tuberculosis would be in which precautions? A. Contact B. Enteric Contact C. Droplet D. Airborn Answer: C - Droplet - Tub
C
4. The major risk factor for development of thyroid cancer is: A. inadequate iodine intake. B. presence of a goiter. C. exposure to radiation. D. smoking.
C
A 44-year-old woman presents with pylelonephritis. The report of her urinalysis is least likely to include: A. WBC casts B. Positive nitrates C. 3+ protein D. rare RBCs
C
All of the following are typical findings for a patient with chancroid except: A. multiple lesions B. Spontaneous rupture of affected nodes C. blood-tinged penile discharge D. dense-matted lymphadenopathy on the ipsilateral side of the lesion
C
Among patients with nephrolithiasis, what is the most common type of kidney stone? A Struvite B Cystine C Calcium oxalate D Uric acid
C
Symptoms in chronic bacterial prostatitis often include: A. Fever B. GI Upset C. Low back pain D. Penile Discharge
C
The nurse practitioner is reviewing the laboratory values of a 28-year-old male patient who presents to the office to establish care with a primary care provider. The lab results from the previous week indicate an A1C of 7.2. The nurse practitioner obtains a fasting blood sugar in the office of 142. The patient denies any significant past medical history and states that he "feels fine." The nurse practitioner recognizes that: A The patient has developed type 1 diabetes. B The patient has developed type 2 diabetes. C The patient has diabetes and further testing is required. S The patient has pre-diabetes.
C
You examine a 28-year-old woman who has emigrated from a country where tuberculosis (TB) is endemic. She has documentation of receiving Bacille Calmette-Guerin vaccine as a child. With this infromation, you consider that: a. she will always have a positive tuberculin skin test result b. biannual chest radiographs are needed to assess her health status accurately c. a TST finding of 10 mm or more induration should be condiered a positive result d. isoniazid therapy should be given for 6 months before TST is undertaken
C
You see a 42 year old man with uncomplicated urogenital gonorrhea. His medical record indicates a severe allergic reaction to PCN that includes difficulty breathing and diffuse urticaria. You recommend treatment with: Oral cefixime Parenteral levofloxacin Oral azithromycin plus oral gemifloxacin Parenteral tigecycline plus oral metronidazole
C
In prescribing levothyroxine therapy for an elderly patient, which of the following statements are true? A. Elderly persons require rapid initiation of levothyroxine therapy B. TSH should be checked about 2 days after a dosage adjustment C. The levothyroxine dose needed by elderly persons is 75% or less of that is needed by younger adults D. TSH should be suppressed to a nondetectable level.
C Rationale: For an elderly person, the anticipated dosage is 75% or less of the adult dosage. Due to the long half-life the effects of a dosage adjustment would not cause a change in the TSH level five or six drug half-lives which would be approximately 6-8 weeks.
Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. Long-term exposure to corticosteroids. B. A benign tumor of the adrenal gland C. A benign pituitary tumor D. An ectopic tumor that produces ACTH
C. a benign pituitary tumor. Cushing's disease is specific to the development of Cushing's syndrome caused by a benign tumor of the pituitary gland that overproduces ACTH (C). Incorrect: Excessive cortisol production can be caused by a benign tumor of the adrenal gland that overproduces cortisol (B), or an ectopic tumor that produces ACTH, which signals excessive production of cortisol in the adrenal gland (D). However, these are not specific to Cushing's disease, which is caused by a benign tumor of the pituitary gland. Long-term exposure of corticosteroids can result in Cushing's syndrome but not Cushing's disease (A).
When a positive HIV test result is obtained, which of the following statements is more accurate in communicating results to the patient? A. Optimally, communication of positive results should be done through in-person contact. B. An English-speaking first-degree relative can be used as a translator when the patient is not proficient in the English language. C. Text messaging or e-mail can be used to communicate results if the contact information is provided by the patient and the patient agrees to this at the time of testing. D. It is appropriate to inform the spouse or partner of a positive test result if the patient is unavailable.
Correct answer: A. Optimally, communication of positive results should be done through in-person contact. The CDC recommends that health-care providers have protocols in place to notify patients about positive HIV results. Optimally, this should be done confidentially and person-to-person (A). In some states, this is required by law.
A 33-year-old woman works in a small office with a man recently diagnosed with active pulmonary TB. Which of the following would be the best care plan for this woman?A. She should receive TB chemoprophylaxis if her TST result is 5 mm or more in induration. B. Because of her age, TB chemoprophylaxis is contraindicated even in the presence of a positive TST result. C. If the TST result is positive but the chest radiograph is normal, no further evaluation or treatment is needed. D. Further evaluation is needed only if the TST result is 15 mm or more in induration.
Correct answer: A. She should receive TB chemoprophylaxis if her TST result is 5 mm or more in induration. For an individua with recent contact with a person with documented TB disease, a TST result of 5 mm or more is considered positive. To prevent active TB, chemoprophylaxis should be considered with a positive TST result (A).
3. First-line treatment options for primary syphilis include: A. IM penicillin B. PO ciprofloxacin C. PO doxycycline D. IM ceftriaxone
Correct answer: A. The preferred treatment of primary syphilis is IM penicillin given as a one-time dose (A).
The hormone cortisol plays a role in all the of the following processes except: A. Maintaining glucose control. B. Maintaining thyroid function. C. Suppressing the immune response. D. Helping the body respond to stress.
Correct: B. maintaining thyroid function. Cortisol is a glucocorticoid produced by the adrenal glands that serves a variety of functions in the body. However, it does not have a role in maintaining thyroid function (B), which is typically controlled by TSH produced in the pituitary gland.
8. Criteria for the diagnosis of T2DM include: A. classic symptoms regardless of fasting plasma glucose measurement. B. plasma glucose level of 126 mg/dL (7 mmol/L) as a random measurement. C. a 2-hour glucose measurement of 156 mg/dL (8.6 mmol/L) after a 75-g anhydrous glucose load. D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8-hour or greater fast on more than one occasion.
Correct: D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8-hour or greater fast on more than one occasion. Several criteria can be used to make a diagnosis of T2DM. These include a fasting plasma glucose greater than or equal to 126 mg/dL (7 mmol/L) (D), or a random plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) along with classic symptoms of disease. Alternatively, a 2-hour plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) after a 75-g glucose load can be used, as well as an A1c 6.5% or greater. The A1c should be repeated in asymptomatic adults with a serum glucose level less than 200 mg/dL (11.1 mmol/L). Incorrect: Classic symptoms should be accompanied with a random plasma glucose of greater than 200 mg/dL (11.1 mmol/L) (A, B). A 2-hour plasma glucose after a 75-g glucose load should be greater than 200 mg/dL (11.1 mmol/L) for a T2DM diagnosis (C).
(3) Example of nonpharmacological treatment that can be used in conjunction with analgesics during acute pain are a. Heat or Ice b. immobilization or exercise such as physical therapy c. Acupuncture,massage,TENS, d. All of the above
D
. All of the following groups are considered complicated urinary tract infections, except: A. males. B. Infants. C. Pregnant women. D. Middle-aged women
D
1. Most common STDs in the U.S include A. Gonorrhea B. Herpes C. Chlamydia D. All the Above
D
2. Sadie, age 40, has just been given a diagnosis of Graves 'disease. She has recently lost 25 lb, has palpitations, is very irritable, feels very warm, and has a noticeable bulge on her neck. The most likely cause of her increased thyroid function is: A. hyperplasia of the thyroid. B. an anterior pituitary tumor. C. a thyroid carcinoma. D. an autoimmune response.
D
A 34 year old woman complains of progressive weakness, fatigue, poor appetite, and weight loss. She has also noticed hyperpigmentation, mainly on the knuckles, elbow and knees. All of the following blood tests can be used to help confirm a diagnosis of Addison's disease except? A. Sodium B. Potassium C. Cortisol D. Folate
D
A 34-year-old woman complains of progressive weakness, fatigue, poor appetite, and weight loss. She has also noticed a development of hyperpigmentation, mainly on the knuckles, elbows, and knees. All of the following blood tests can be used to help confirm a diagnosis of Addison's disease except: Sodium Potassium Cortisol Folate
D
All the following are true regarding the use of examining the CD4 T-cell count except which one? A Used to stage HIV infection and to determine response to antiretroviral therapy (ART) B When count goes up, it means that the patient is responding to antiretroviral therapy (ART) C Values vary throughout the day, so it's best to check at the same time of day, using the same laboratory D When the count goes down, it means that the patient is responding to antiretroviral therapy (ART)
D
Compared with TST, potential advantages of the Quanriferon TB Gold test (QTF-G) include all of the following except: a. the ability to have the entire testing process complete with one clinical visit. b. the results are available within 24 hours c. the interpretation of the test is not subject to reader bias d. it is able to predict who is at greatest risk for active disease development.
D
Risk factors for the development of infection reactivation in patients with latent TB infection include all of the following except: a. diabetes mellitus b. immunocompromise c. long-term oral corticosteroid therapy d. male gender
D
What are the signs/symptoms of lower back pain? A. Limited range of motion B. Normal to guarded posture C. Limp while ambulating D. All of the above
D
Which of the following best describes the characteristics of a friable cervix? A The presence of vesicular lesions B A constant burning sensation felt deeply in the vagina C The presence of multiple cyst-like lesions on the cervix D Easily irritated and prone to bleeding, especially following intercourse
D
3. Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are both markers for pre-diabetes. Both IFG and IGT are closely associated with: a. Autoimmune disorders such as hypothyroidism, rheumatoid arthritis, and Sjogren's syndrome b. Elevations in liver enzymes and inflammatory markers such as C-reactive protein c. Obesity, coronary artery disease, and peripheral vascular disease d. Central obesity, high triglycerides, low HDLs, and hypertension
D. Obesity, high triglycerides, low HDL and hypertension
What are risk factors for metabolic syndrome? A Obesity B Insulin-resistant type 2 diabetes C Hypertension D Hyperlipidemia E All of the above
E
2. True or False: If there is one STD, there cannot be any others.
False
Clinical presentation of progressive primary TB most commonly includes all of the following except: Malaise Fever Dry Cough Frank hemoptysis
Frank hemoptysis
3. First line treatment options for primary syphilis include: IM penicillin PO ciprofloxacin PO doxycycline IM ceftriaxone
IM penicillin
2. A patient presents to the primary care office for an initial evaluation. The patient is complaining of polyuria and polydipsia and exhibits symptoms of dehydration. An A1C is obtained that reveals an A1C of 12.7%. The nurse practitioner should initiate therapy with: a. Metformin b. A GLP-1 RA c. Insulin d. A sulfonylurea
Insulin: A patient with an A1C of 12.7% is considered to be "glucose toxic," and insulin is the recommended therapy. Later, when the A1C improves to < 9%, the patient may consider alternative therapies.
Which statement accurately describes HSV? A HSV is a chronic, life-long viral infection B HSV cannot be spread when the person with the disease is asymptomatic C Most individuals with HSV are aware they have it D HSV is an acute and easily treatable infection
NSWER: A (HSV is a chronic, life-long viral infection). Individuals with HSV have it for life. HSV can spread during asymptomatic periods. Most individuals with HSV are unaware they have it.
True or False Anti-inflammatory are not recommend for the elderly as a general rule due to the effects of medication on the kidneys and cardiovascular sysytem
TRUE
(2) True or False Anti-inflammatory are not recommend for the elderly as a general rule due to the effects of medication on the kidneys and cardiovascular sysytem
True
1) Physiological changes that occur in the elderly such as decreased body mass, hepatic dysfunction,and renal dysfunction may cause a. increased serum drug concentration of pain medication b. Decreased serum drug concentration of pain medication c.Increased serum drug concentration and decreased serum drug concentration d. none of the above
a
Physiological changes that occur in the elderly such as decreased body mass, hepatic dysfunction,and renal dysfunction may cause a. increased serum drug concentration of pain medication b. Decreased serum drug concentration of pain medication c.Increased serum drug concentration and decreased serum drug concentration d. none of the above
a
1. The nurse practitioner is reviewing the laboratory values of a 28-year-old male patient who presents to the office to establish care with a primary care provider. The lab results from the previous week indicate an A1C of 7.2. The nurse practitioner obtains a fasting blood sugar in the office of 142. The patient denies any significant past medical history and states that he "feels fine." The nurse practitioner recognizes that: The patient has developed type 1 diabetes The patient has developed type 2 diabetes The patient has diabetes and further testing is required The patient has pre-diabetes
c. further testing is required: The patient meets the criteria to be diagnosed with diabetes. The clinician would be unable to determine what type of diabetes the patient has without further testing.
(3) Example of nonpharmacological treatment that can be used in conjunction with analgesics during acute pain are a. Heat or Ice b. immobilization or exercise such as physical therapy c. Acupuncture,massage,TENS, d. All of the above
d
. Which of the following antigens is a component of the HIV ½ combination antibody/antigen testing? p24 p20 P18 P14
p24
